Postabortion care: 20 years of strong evidence

Worldwide 75 million women need postabortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. After 20 years of strong evidence, this article presents findings that impact practices and health outcomes.

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IntroductionWorldwide, 210 million women become pregnant annually; 135 million will have a live birth, and 75 million, or one-third, will have a spontaneous or induced abortion and need postabortion care (PAC). Of the 75 million abortions, 31 million are spontaneous (miscarriages) and 44 million are induced; half of the induced abortions are unsafe, performed by persons lacking the necessary skills or in an environment not in conformity with minimal medical standards.

Since 1994, the United States Agency for International Development (USAID) has supported implementation of PAC programs in more than 40 countries to address complications related to miscarriage and incomplete abortion. PAC may be a unique service delivery model that is both curative and preventative—curative in treating incomplete abortion and the symptoms of hemorrhage and sepsis; preventative in providing family planning services to address unmet need for contraception and reduce unintended pregnancies and repeat abortions.

The 3 components of USAID’s PAC model are:

1. Emergency treatment

2. Family planning counseling and service delivery, and where financial and human resources exist, evaluation and treatment of sexually transmitted infections (STIs) as well as HIV counseling and/or referral for testing

3. Community empowerment through community awareness and mobilization

PAC is an integral part of maternity care, and all components of PAC services are essential, as stated at the 1994 International Conference on Population and Development. All 3 components have been included in USAID programs since 1994.

In 2007, USAID published the first global PAC research compendium, “What Works, A Policy and Program Guide to the Evidence on Postabortion Care,” which reviewed the PAC literature from 1994 through 2003. This article summarizes the major findings on PAC interventions with strong evidence, described in the forthcoming second edition of USAID’s global PAC research compendium. The second edition builds on the first edition by including more detailed findings that address the cycle of repeated unintended pregnancy and abortion.

Palladium's Sara Pappa, Senior Associate of Health, contributed to this article in the Global Health: Science and Practice Journal. To view the article in full, please click here.